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Serial Changes in Cognitive Function After TAVR
Study Questions:
What are the changes in global cognition and specific cognitive domains up to 1 year post- transcatheter aortic valve replacement (TAVR)?
Methods:
Fifty-one patients (median age, 80.0 [interquartile range, 72-85] years; 37% women) underwent TAVR and prospective assessment of cognitive function using the Montreal Cognitive Assessment (MoCA) at baseline, short-term (30 days), and 1 year post-TAVR. Processing speed and executive cognitive functions were further evaluated with the digit-symbol substitution test (DSST), Trail Making Tests (TMT), and verbal fluency tests at the same time points. Cognitive decline (CD) was determined by changes in mean scores and as a rate using practice-corrected reliable change index (RCI).
Results:
The baseline mean total MoCA score was 22.7 ± 3.84. Twenty patients (39.2%) were considered cognitively impaired using a cutoff of <23 of 30 points. Mean total MoCA score improved at short-term post-TAVR and remained stable at 1 year (p = 0.022). On the basis of the RCI of total MoCA score, four patients (7.8%) presented with short-term CD, which persisted at 1 year in one patient (2.0%). Four patients (7.8%) exhibited cognitive improvement at 1 year, increasing to 15% among those with baseline cognitive impairment. No significant changes were observed over time in the mean DSST, TMT, and verbal fluency test scores. On the basis of the RCI, 10 of 40 patients (25%) presented with a reduction in performance of at least one test at 30 days that persisted at 1 year in four patients (10%).
Conclusions:
The authors concluded that TAVR was associated with global improvement in cognitive status, more pronounced among those with cognitive impairment pre-TAVR.
Perspective:
This study reports that both global and domain-specific cognition tended to improve in the short-term post-TAVR, remaining stable compared with baseline at the 1-year follow-up. However, an early decline in some complex cognitive functions was observed in about one-fourth of patients, and persisted in 40% of them at the 1-year follow-up. Additional studies are required to determine clinical predictors of changes in cognitive status following TAVR, and to evaluate the implementation of potential preventive measures of cognitive decline.
Keywords: Aortic Valve Insufficiency, Cognition, Cognition Disorders, Heart Valve Diseases, Primary Prevention, Trail Making Test, Transcatheter Aortic Valve Replacement
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